Influence of Gum Chewing on Postoperative Bowel Activity After Complete Staging Surgery for Gynecological Malignancies

Abstract

One important factor affecting early recovery in patients undergoing open complete staging surgery for gynecological malignancies is the return of normal bowel function. Gum chewing is a simple and inexpensive intervention that facilitates early recovery of bowel function in patients undergoing several types of gastrointestinal surgery. No previous study has investigated the possible favorable effects of gum chewing on return of bowel function in patients undergoing elective total abdominal hysterectomy and systematic retroperitoneal lymphadenectomy. This randomized controlled trial was designed to assess the effectiveness of gum chewing for return of postoperative bowel function in patients undergoing abdominal complete staging surgery for gynecological malignancies. Participants were women undergoing abdominal complete surgical staging for various gynecological cancers. A total of 149 patients were randomized to a gum-chewing group (n = 74) or a control group (n = 75) who received no treatment. Gum chewing began on the first postoperative day. Patients chewed sugar-free gum 3 times daily until the first passage of flatus. Each session of chewing lasted 30 minutes. All patients underwent total abdominal hysterectomy and had systematic pelvic and para-aortic lymph node dissection as part of complete staging surgery. Postoperative outcome measures included time to first bowel movement, time to passage of first flatus and feces, time to tolerate oral feeding, need for antiemetics and analgesics, mild ileus rate, and length of hospital stay. There was significant improvement in the gum-chewing group compared with the control group for the following outcomes: mean time to bowel movement (41.5 ± 15.7 vs 50.1 ± 15.9 hours; P < 0.001), mean time to flatus (34.0 ± 11.5 vs 43.6 ± 14.0 hours; P < 0.001), mean time to defecation (49.6 ± 18.7 vs 62.5 ± 21.5 hours; P < 0.001), mean time to tolerate diet (4.0 ± 0.8 vs 5.0 ± 0.9 days; P < 0.001), and mean length of hospital stay (5.9 ± 1 vs 7.0 ± 1.4 days; P < 0.001). Mild ileus symptoms occurred in 27 patients (36%) in the control group and 11 patients (14.9%) in the gum-chewing group; the relative risk was 2.4 with a 95% confidence interval of 1.2 to 4.5; P = 0.004. Two patients (27%) in the control group had severe ileus symptoms. There were no adverse effects in the gum-chewing group. These data show that use of gum chewing early in the postoperative period following elective total abdominal hysterectomy and systematic retroperitoneal lymphadenectomy hastens time to bowel recovery. Gum chewing reduced time to the first flatus and defecation, time to first bowel movement, and time to tolerate oral feedings. The investigators believe that this inexpensive and well-tolerated intervention should be added as an adjunct treatment in postoperative care of patients in this population.